In severe injuries ligaments, tendons and muscle tissue surrounding the bones can be torn or otherwise detached from the skeletal structure. Often the ligaments or tendons are so damaged that they must be replaced using cadaver ligaments or tendons or other sources of such tissue. In other cases tissue such as cartilage is worn or degenerated and the repair includes transplanting typically from the patient/donor.
Whether detached tissue is repairable or if replacement tissue is required, the primary goal of the surgeon is to insure the tissue is held securely against the bone mass or internal thereto so the detached tissue or implanted tissue can grow and physically attach itself or reattach to the bone.
Sutures are commonly used in such procedure. A number of methods for securing a tissue to a body part have been disclosed. U.S. Pat. No. 4,244,370 taught the use of positioning an implant within the soft body tissue, but was not concerned with anchoring the tissue to the bone mass. Improvements of attachment involve the anchoring of the tissue directly to the bone mass. U.S. Pat. No. 4,632,100 and U.S. Pat. No. 6,916,333 both teach novel anchors for use in such procedures. U.S. Pat. No. 6,875,216 disclosed the use of a tapered bioabsorbable interference screw for endosteal fixation of ligaments and U.S. Pat. No. 7,063,717 teaches a biointerference screw fixation technique that is particularly beneficial in anterior cruciate ligament (ACL) reconstruction.
Regardless of the procedure or technique employed each of these prior art systems rely on the body's ability to facilitate a permanent reattachment to the bone. Accordingly these mechanical fasteners improve the successful outcome of the surgery only to the extent the patient's body responds properly as is true in any surgical procedure.
Accordingly the period of time immediately after surgery and during rehabilitation are critical in that the reconstructed ligaments or tendons are more susceptible to damage until regrowth and reattachment to the bone mass occurs. Similarly in the case of cartilage transplants the removal of healthy cartilage and placement in a damaged area from a donor/patient is a common practice which is taught in U.S. Pat. No. 5,919,196. The resultant holes in the removal site and the transplant site need to have the surrounding bone and tissue grow in to the cavities for proper healing.
With young healthy patients the time to achieve regrowth is usually quicker, but the natural high activity of these patients' means that the risk of re-injury is greater during the time after surgery and prior to full attachment.
Conversely more elderly patients require a longer time to achieve reattachment, but are less active generally and therefore the risk of re-injury is over a longer time, but at a lower presumed level.
In either group of patients, the need exists to reduce the time required to achieve reattachment of the ligament or tendons to the bone mass or acceptance of the cartilage transplant to insure a successful recovery and full use of the limb.
In PCT patent application PCT/US 05/36455 a novel method of using non focused shock waves was disclosed to treat a variety of conditions within tissues and organs. The US patent priority applications were 2006/0100550 A1 and 2006/0036195 A1 which are incorporated herein by reference. This use of such shock waves in combination with mechanical fastening of tendons or ligaments is described below.